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Bromocriptine for High Dose Insulin Therapy Type 2 Patients

Jul 24, 2015
 

Treatment can decrease amount of total daily insulin dose due to insulin sensitizer properties…

As the duration of diabetes diagnosis lengthens for patients, management of the disease gets more difficult. Insulin therapy is very effective in treating hyperglycemic events, however it carries unwanted side effects such as hypoglycemia and weight gain. Also, administration of high dose insulin becomes challenging due to the large volume and numerous injections. This can lead to a submaximal effect of insulin administration. One approach to treating patients with sensitivity properties is to add an insulin sensitizer. Bromocriptine is a unique insulin sensitizer with a great safety profile, however there is limited evidence about bromocriptine effects in patients taking high dose insulin.

In a recent pilot study, researchers examined the use of morning bromocriptine-QR therapy in improving glycemic control and decreasing the use of insulin in type 2 diabetic patients. Ten patients taking > 65 units/day of insulin therapy and metformin (1-2g in two divided doses) participated. The patients were started on bromocriptine 0.8mg and the dose was titrated up weekly until a maximum dose was tolerated (1.6 to 4.8mg). This schedule was achieved in 6 weeks and each week patients were contacted to report any side effects and tolerability. HbA1c levels were measured at 8, 16, and 24 weeks.

The results showed that the average HbA1c decreased by 1.76 (9.74 + 0.56 to 7.98 + 0.36, P=0.01). The mean total daily dose of insulin decreased 27% (199 + 33 to 147 + 31, P=0.009). The postprandial glucose area under the curve (AUC60–240) decreased 32% (P=0.04) during the treatment period. The decrease in total daily dose of insulin was observed at 8 weeks and sustained over the remaining 16-week study duration.

The researchers concluded that bromocriptine-QR therapy can be beneficial for type 2 diabetes patients taking high doses of insulin.

Practice Pearls:

  • In patients who inject > 65 units/day, bromocriptine is useful in decreasing HbA1c levels.
  • This study suggests that bromocriptine usage can decrease the amount of the total daily dose of insulin due to its insulin sensitizer properties.
  • The addition of bromocriptine is a great option for poorly controlled patients on high-dose insulin therapy.

Roe ED, Chamarthi B, Raskin P. “Impact of Bromocriptine-QR Therapy on Glycemic Control and Daily Insulin Requirement in Type 2 Diabetes Mellitus Subjects Whose Dysglycemia Is Poorly Controlled on High-Dose Insulin: A Pilot Study.” J Diabetes Rea. 2015.